MEDICARE: DR. CHRISTOPHER TODD NICHOLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	00023044	AL
2	208100000X	Physical Medicine & Rehabilitation Physician	311032	LA
3	207RB0002X	Obesity Medicine (Internal Medicine) Physician	01094928A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417915596	OTHER	LA	AETNA
2	1417915596	OTHER	LA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417915596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER TODD NICHOLS MD

Provider Business Mailing Address
First Line	:	PO BOX 74008272
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-8272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 WATTERSON PKWY
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-2307
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:	702-977-1496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	04/09/2026

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